Gastroenteritis

Objectives
• To learn about various types of gastroenteritis.

• To learn the management of gastroenteritis.

• To learn about functional foods.

• To know the choices and future of ORS.
 Gastroenteritis
• Inflammation of stomach or intestines
– Inhibits nutrient absorption and excessive H2O and
electrolyte loss
• Bacterial
• Viral
• Parasites
• Poisoning by microbial toxins
– food borne intoxication
• Signs and Symptoms:
– General features: diarrhea, loss of appetite, abdominal
cramps, nausea, vomiting and possibly fever
– Dysentery
– Typically self Limiting

• Enteric fevers
– Systemic with severe headache, high fever, abscesses,
intestinal rupture, shock and death
• Prevention
– Hand washing
– Proper food handling and complete cooking
– Pasteurization of milk and juices
– Adequate sanitation

– Safe water supplies

• Treatment
– Rapid replacement of fluids and electrolytes
– Anti-nausea medication
– Antimicrobials may be used in severe cases
 Bacterial Gastroenteritis

• 3 groups of gram negative bacteria account for most

bacterial intestinal infections:
– Vibrio cholerae (Cholera)
– Enterics (Salmonella, Shigella, E. coli)

– Campylobacter jejuni
 Viral Gastroenteritis
• Epidemology
– Infect intestinal cells causing cell death
– Typically self-limiting
– Norovirus epidemics cause 90% of cases
– Rotaviruses responsible for 50% infant cases of serious diarrhea
• 600,000 worldwide annual fatalities

• Oral vaccine available

 Approach

• Objectives
– Assess the degree of dehydration
– Prevent spread of the enteropathogen

– Selectively determine etiology and provide specific

therapy
• Basic guidelines for the management of dehydration

• ORS should be use for rehydration

• Oral rehydration should be performed within 3-4 hr

• Rapid realimentation, an age-appropriate unrestricted diet is recommended

as soon as dehydration is corrected. Gut rest is not indicated

• In breastfeed infants, nursing should continue

• Diluted formula or special formulas are not indicated

• Additional ORS can be administer for ongoing losses

• No unnecessary labs or medications (i.e. antidiarrheals)

• PREVENTIVE PRACTICES ARE:

• � breastfeeding.

• � appropriate weaning.

• � care in preparation and storage of food.

• � use of clean, safe water for drinking and hygiene.

• � hand-washing with soap and water.

• � proper disposal of stools of young children.

• � use of latrines.

• � immunization against measles.

 Home Management of Diarrhea

• Therapy should begin at home as long as

caregivers are instructed properly regarding
signs of dehydration or are able to determine
when children appear markedly ill or appear
not to be responding to treatment.
 Therapy of Minimal Dehydration
• Minimal dehydration (<3% loss of body wt)
– Encourage use of ORS
– Nutrition should not be restricted
 Functional Foods - Definitions
• Functional foods can be defined as foods that have an
effect on physiologic processes separate from their
established nutritional function.
– Probiotics are live microorganisms in fermented foods that
promote optimal health by establishing an improved balance in
intestinal microflora.
– Prebiotics are complex carbohydrates used to preferentially
stimulate the growth of health-promoting intestinal flora.
 Choice of ORS
• In May 2002, WHO announced a new ORS formulation consistent
with these recommendations, with 75 mEq/L sodium, 75 mmol/L
glucose, and total osmolarity of 245 mOsm/L.
– World Health Organization. Oral rehydration salts (ORS): a new reduced osmolarity
formulation. Geneva, Switzerland: World Health Organization, 2002.

• The composition of available oral rehydration solutions is distinct

from other beverages frequently used inappropriately for
rehydration.
 Future Possibilities for ORS

• Potential future additives to ORS include

– substances capable of liberating short-chain fatty acids
and partially hydrolyzed guar gum
– probiotics
– prebiotics
– zinc
– protein polymers / amino acids